TRAVEL ALERT - TROPICAL DESTINATIONS

Dr. Scappatura's Travel Medicine Center is located at 700 Bay St., Ste. 609, Toronto, Ontario, M5G 1Z6, Tel: 416-340-8222. For more detailed information visit www.travelclin.com

Toronto, Canada: Travel to tropical countries can be an expensive proposition especially for those on a tight budget. It can also turn into a nightmare for tourists who learn a little too late about the unforeseen dangers.

The cost of vaccines and medication for malaria and diarrhea and the de-listing of medical visits for travel have added to this financial burden. Medical visits can cost from $30 to $100 and vaccine costs can run from $60 to $110 for modest trips to $400 or more for a long overseas adventure.

First, go to a reputable travel clinic. If you haven't been to one before that you trust, ask your friends or fellow travelers and shop around. Check with the clinic's receptionist or web site for information regarding the cost of visits and vaccines. The major advantage of a good travel clinic is their expertise in assessing your individual risk. Most family physicians and walk-in clinics look up a list of recommended vaccines and anti-malarials for a country. This list is almost always the maximum number of shots you might need. Most travelers will not need all these shots.

For instance if you look up Thailand and see that there is Hepatitis A & B, typhoid, cholera, polio, Japanese encephalitis, rabies and malaria, you might expect a lot of shots. Many travelers are given vaccines when they may be at low risk. A mosquito that bites at night and is mainly in rural areas during the rainy season transmits Japanese encephalitis. Malaria in Thailand is resistant to many drugs, but is largely confined to remote rural area along the Myanmar (Burma) and Cambodia borders not visited by most travelers. Typhoid can be avoided by ensuring safe food and water and serious cholera is extremely rare in travelers.

Most business travelers and affluent travelers to cities and major resort areas don't need any of these shots. Backpackers, hikers or long term travelers may need some or all of these depending on the time of year and climate, the exact area they are traveling to and how careful they will be while they are traveling. Travelers who go to a reputable travel clinic usually end up getting less vaccines and go on anti-malarial medications for shorter periods of time than those who are subjected to the cookbook method.

Some clinics will only give you one or two vaccines per visit and ask you to come back four or five times. This didn't cost you anymore when the visits were covered by OHOP, but it may now. Some shots have to be given in a series of three so you may need more visits. If you are not getting these vaccines you can often get four or five shots (and sometimes more) on one visit and be finished.

Many clinics do not have all vaccines, especially Yellow Fever. If you go to one of these clinics and pay for a visit then have to go to a reputable travel clinic for the Yellow Fever shot, you end up paying for two visits.

Travel clinics often carry vaccine in multidose vials. Menigococcal (meningitis) vaccine can cost $45-$50 in a single dose vial, but travel clinics can give a dose from a multi-dose vial for $25-$30 per dose.

Secondly, plan your trip and bring your itinerary. If you aren't sure where you are going or how long you will be in a particular area, you may either end up getting more shots than you need or having to come back for a second visit for some you missed on the first visit. You may also get two months' worth of malaria pills when you are really only at risk for two weeks. At $5-7 per week this can add up.

Be flexible. If you change your plans slightly you may avoid a vaccine or take less of an antimalarial drug. A one-month high altitude trek in Nepal with a stopover in New Delhi for a few days may be a risk for malaria. If you stop over in Bangkok or fly direct you aren't at risk. You take anti-malarial medication a week before and for four weeks after leaving an area with malaria. If you are on a three-month trip and enter an area with malaria for one week the first month and one week the last month you will take 12 weeks of an anti-malarial drug for two weeks in areas of risk. If you go to one risk area directly after the other you will still be at risk for two weeks, but only take seven weeks of the drug.

Thirdly, bring all your records of previous vaccines with you. If you know what you've already had you will avoid getting unnecessary doses of expensive vaccines and avoid return visits for vaccines you thought you already had. Reputable travel clinics will give you a record of your shots and some keep computerized databases so your records are available immediately for your next trip.

You may be in a high-risk group because of some medical condition (transplant, HIV infection, previous history of depression or neurological or psychological problems, pregnancy, etc.). You should be seen in a travel clinic experienced with these groups. You are often at higher risk if you catch a disease, but cannot be fully protected by vaccines or drugs because of complications or contraindications related to your condition.